Articles: nerve-block.
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Reg Anesth Pain Med · Aug 2020
ReviewAnatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy.
Safety and effectiveness are mandatory requirements for any technique of regional anesthesia and can only be met by clinicians who appropriately understand all relevant anatomical details. Anatomical texts written for anesthetists may oversimplify the facts, presumably in an effort to reconcile extreme complexity with a need to educate as many users as possible. When it comes to techniques as common as upper-extremity blocks, the need for customized anatomical literature is even greater, particularly because the complex anatomy of the brachial plexus has never been described for anesthetists with a focus placed on regional anesthesia. ⋯ They describe the anatomy of the brachial plexus (ventral rami, trunks, divisions, cords, and nerves) in relation to the topographical regions used for access (interscalene gap, posterior triangle of the neck, infraclavicular fossa, and axillary fossa) and discuss the (interscalene, supraclavicular, infraclavicular, and axillary) block procedures associated with these access regions. They indicate allowances to be made for anatomical variations and the topography of fascial anatomy, give recommendations for ultrasound imaging and needle guidance, and explain the risks of excessive volumes and misdirected spreading of local anesthetics in various anatomical contexts. It is hoped that clinicians will find this article to be a useful reference for decision-making, enabling them to select the most appropriate regional anesthetic technique in any given situation, and to correctly judge the risks involved, whenever they prepare patients for a specific upper-limb surgical procedure.
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Reg Anesth Pain Med · Aug 2020
CommentCurrent versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model.
Recent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for fluoroscopic-guided GN-RFA in cadaveric models. ⋯ This study demonstrates that the revised targets are more accurate than the current targets for GN-RFA.
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Review Meta Analysis
Efficacy of transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis.
Multimodal opioid-sparing analgesia is a key component of the enhanced recovery after surgery (ERAS) protocol for postoperative pain management. Transversus abdominis plane (TAP) block has contributed to the implementation of this approach in different kinds of surgical procedures. The aim of this study was to evaluate the efficacy of TAP block and its impact on recovery in colorectal surgery. ⋯ TAP block appears to provide both an effective analgesia and a significant reduction in opioid use on the first postoperative day after colorectal surgery. Its use does not seem to lead to increased postoperative complications.